1 Dead in Attic (37 page)

I'm no Tom Cruise; psychiatry is fine, I thought. For other people.

My very first exchange with my doctor had a morbidly comic element to it; at least I thought so, but my sense of humor was in delicate balance, to be sure.

While approaching his office, I noticed a dead cat in his yard. Freshly dead, with flies just beginning to gather around the eyes. My initial worry was that some kid who loves this cat might see it, so I said to him, “Before we start, do you know about the cat?”

Yes, he told me. It was being taken care of. Then he paused and said, “Well, you're still noticing the environment around you. That's a good sign.”

The analyst in him had already kicked in. But the patient in me was still resisting. In my lifelong habit of dampening down any serious discussion with sarcasm, I said to him, “Yeah, but what if the dead cat was the
only
thing I saw? What if I didn't see or hear the traffic or the trees or the birds or anything else?”

I crack myself up. I see dead things. Get it?

Yeah, neither did he.

We talked for an hour that first appointment. He told me he wanted to talk to me three or four times before he made a diagnosis and prescribed an antidote. When I came home from that first visit without a prescription, my wife was despondent and my editor enraged. To them, it was plain to see I needed something, anything, and fast.

Unbeknown to me, my wife immediately wrote a letter to my doctor, pleading with him to put me on medication. Midway through my second session, I must have convinced him as well, because he reached into a drawer and pulled out some samples of a drug called Cymbalta.

He said it could take a few weeks to kick in. Best case, he said, would be four days. He also said that its reaction time would depend on how much body fat I had; the more I had, the longer it would take. That was a good sign for me. By August, far from putting on the Katrina 15, I had become a skeletal version of my pre-K self.

Before I left that second session, he told me to change the message on my phone, that “emotionally unavailable” thing. Not funny, he said.

•  •  •

I began taking Cymbalta on August 24, a Thursday. As I had practically no body fat to speak of, the drug kicked in immediately. That whole weekend, I felt as if I were in the throes of a drug rush. Mildly euphoric, but also leery of what was happening inside of me. I felt off balance. But I felt better, too.

I told my wife this, but she was guarded. I've always heard that everyone else notices changes in a person who takes an antidepressant before the patient does, but that was not the case with me.

“I feel better,” I told Kelly but my long-standing gloom had cast such a pall over our relationship that she took a wait-and-see attitude.

By Monday, I was settled in. The dark curtain had lifted almost entirely. The despondency and incapacitation vanished, just like that, and I was who I used to be: energetic, sarcastic, playful, affectionate, and alive.

I started talking to Kelly about plans—a word lacking from my vocabulary for months. Plans for the kids at school, extracurricular activities, weekend vacations. I had not realized until that moment that while stuck in my malaise, I had had no vision of the future whatsoever.

I han't been planning anything. It was almost like not living.

Kelly came around to believing. We became husband and wife again. We became friends.

It all felt like a Come to Jesus experience. It felt like a miracle. But it was just medicine, plain and simple.

I asked my doctor to tell me exactly what was wrong with me so I could explain it in this story. I will be candid and tell you I still don't really understand it, the science of depression, the actions of synapses, transmitters, blockers, and stimulants.

I've never been much at science. I guess I'm just a fragile poet after all.

The diagnoses and treatments for depression and anxiety are still a developing science. The
Diagnostic and Statistical Manual of Mental Disorders
—psychiatry's chief handbook—practically doubles in size every time it's reprinted, filled with newer and clearer clinical trials, research, and explanations.

Does that mean more people are getting depressed? Or that science is just compiling more data? I don't know.

Measuring depression is not like measuring blood sugar. You don't hit a specified danger level on a test and then you're pronounced depressed. It is nuance and interpretation and there is still a lot of guesswork involved.

But here's my doctor's take: The amount of cortisol in my brain had increased to dangerous levels. The overproduction, in turn, was blocking the transmission of serotonin and norepinephrine.

Some definitions: Cortisol is the hormone produced in response to chronic stress. Serotonin and norepinephrine are neurotransmitters—chemical messengers—that mediate messages between nerves in the brain, and this communication system is the basic source of all mood and behavior.

The chemistry department at the University of Bristol in England has a massive Web database for serotonin, titled, appropriately, “A Molecule of Happiness.”

And I wasn't getting enough. My brain was literally shorting out. The cells were not communicating properly. Chemical imbalances, likely caused by increased stress hormones—cortisol, to be precise—were dogging the work of my neurotransmitters, my electrical wiring. A real and true physiological deterioration had begun.

I had a disease.

This I was willing to accept. Grudgingly, for it ran against my lifelong philosophy of self-determination.

I pressed my doctor: What is the difference between sad and depressed? How do you know when you've crossed over?

“Post-traumatic stress disorder is bandied about as a common diagnosis in this community, but I think that's probably not the case,” he told me. “What people are suffering from here is what I call Katrina Syndrome, marked by sleep disturbance, recent memory impairment, and increased irritability.

“Much of this is totally normal. Sadness is normal. The people around here who are bouncing around and giddy, saying that everything is all right—they have more of a mental illness than someone who says, ‘I'm pretty washed out.'

“But when you have the thousand-yard stare, when your ability to function is impaired, then you have gone from ‘discomfort' to ‘pathologic.' If you don't feel like you can go anywhere or do anything—or sometimes, even move—then you are sick.”

That was me.

If that is you, let me offer some unsolicited advice, something you've already been told a thousand times by people who love you, something you really ought to consider listening to this time: Get help.

I hate being dependent on a drug. Hate it more than I can say. But if the alternative is a proud stoicism in the face of sorrow accompanied by prolonged and unspeakable despair—well, I'll take dependency.

I can live with it. I can live with anything, I guess. For now.

Cymbalta is a new generation of antidepressant, a combination of selective serotonin and norepinephrine reuptake inhibitors—SSRIs and SNRIs—the two common drugs for anxiety and depression.

I asked my doctor why he selected it over, say, Prozac or Wellbutrin or any of the myriad antidepressants whose brand names have become as familiar as aspirin in our community.

He replied, “It's a roll of the dice.” He listened to my story, observed me, and made an educated guess. If it didn't work, he said, we'd try something else.

But it worked.

Today I can take my kids to school in the morning and mingle effortlessly with the other parents. Crowds don't freak me out. I'm not tired all day, every day. I love going to the grocery store. I can pump gas. I notice the smell of night-blooming jasmine and I play with my kids and I clean up after my dog and the simplest things, man—how had they ever gotten so hard?

The only effect I have noticed on my writing is that the darkness lifted. I can still channel anger, humor, and irony—the three speeds I need on my editorial stick shift.

And I'm not the only one who senses the change. Everyone tells me they can see the difference, even readers. I'm not gaunt. I make eye contact. I can talk about the weather, the Saints, whatever; it doesn't have to be so dire, every word and motion.

Strange thing is this: I never cry anymore. Ever.

I tell you truthfully that I cried every day from August 29 last year until August 24 this year, 360 days straight. And then I stopped. I guess the extremes of emotion have been smoothed over, but, truthfully, I have shed enough tears for two lifetimes.

Even at the Saints'
Monday Night Football
game, a moment that weeks earlier would have sent me reeling into spasms of open weeping, I held it together. A lump in my throat, to be sure, but no prostration anymore.

The warning labels on antidepressants are loaded with ominous portent, everything from nausea to sexual dysfunction, and, without going into more detail than I have already poured out here, let's just say that I'm doing quite well, thank you.

It's my movie now. I am part of the flow of humanity that clogs our streets and sidewalks, taking part in and being part of the community and its growth. I have clarity, and oh, what a vision it is.

I am not cured, not by any means. Clinical trials show that Cymbalta has an 80 percent success rate after six months, and I'm just two months in. I felt a backward tilt recently—the long stare, the pacing, it crept in one weekend—and it scared me so badly that I went to my doctor and we immediately agreed to increase the strength of my medication.

Before Katrina, I would have called somebody like me a wuss. Not to my face. But it's what I would have thought, this talk of mood swings and loss of control, all this psychobabble and hope-dope.

What a load of crap. Get a grip, I would have said.

And that's exactly what I did, through a door that was hidden from me but that I was finally able to see.

I have a disease. Medicine saved me. I am living proof.

Emphasis on
living
.

Life is full of stunning moments of revelation; couldn't every one of us title our memoirs “Little Epiphanies”?

Certainly my world took a tilt this past Sunday—my privacy and worldview ripped wide open and exposed—when I wrote what I suppose is the most personal story I've ever laid down in print, a story about my yearlong bout with depression.

That term “bout with depression” just makes me cringe. I never would have read such an article had I not written it myself, all maudlin and self-helpy. But that's what it has been. A bout. With depression.

The response has been, to say the least, overwhelming. If you are one of the roughly 1,000 people who e-mailed or called me to say thank you or welcome to the club or hang in there, I want to acknowledge that with gratitude here because the odds of my actually getting an opportunity to respond to all of my recent correspondence are slim. I was already backlogged a few thousand e-mails and phone calls from the past few months, the period in which I sank into an incapacitating abyss.

I mean it. I feel the love, from so many readers, and I appreciate that more than I can say. And answering 1,000 e-mails definitely constitutes more than I can say.

Even to those who suggested I substitute yoga, Jesus, or Saint-John's-wort for my antidepressant medication, I thank you and will take your recommendations under advisement but stick with my doctor's prescribed remedy for now.

There are two correspondences that particularly shook me, one of which I answered and the other I could not. One was from someone in our community who has already attempted suicide and had been in possession of a prescription for antidepressants for weeks but had not gotten it filled.

Maybe he or she would refill it now, the correspondent wrote. But it was expensive. But, after food, I don't know of a better use for money for one who is suicidal than medicine to make you not be.

So, whoever you are . . . please.

The other communication was a letter—unsigned—from someone who told me they were experiencing the same symptoms and despair that I had written about but were seeking an alternative solution.

I had written about three friends who had killed themselves, and this person wrote, “I will not be your fourth friend to die. I am only an acquaintance, so I will be your first, second, third or fourth or fifth to die. My rabbit hole is becoming deeper, more comfortable, more desirable. Your pain and fear is as valid as mine, your depression is as valid as mine. The only difference is that I will stop my pain differently than you.”

Unfortunately, I don't think the writer was referring to yoga, Jesus, or Saint-John's-wort. Do I detect a cry for help? Do I detect a community in crisis, at wit's end? Hell yes, I do. (These were only among the extreme letters I got; there are hundreds that are mere Category 4s.)

Here's a funny thing: In my article about fighting depression, I listed, as one example of the weight that took me down, all the thousands of e-mails I have received over the past year from readers spilling out their own stories of misery and funk. I wasn't assigning blame, mind you, just listing the circumstances that preyed upon me from time to time.

So I have to believe that some readers would have taken this as a mild plea not to burden me anymore with their stories, and still—I got more than a thousand responses from folks telling me that they, too, have felt hope and purpose slipping away as they try to rebuild or even just get back to New Orleans.

How many wanted to write but didn't because they thought they might send me into a tailspin? I don't know. But I'm glad people did write to me because I have accumulated a mind-boggling compilation of stories that capture the emotional landscape of life after the flood and I don't know what the hell I'll do with it but someday, someone smarter than me can take a look at it all and tell us just what happened here.